Restarting the Sleeping Brain with Targeted Tinnitus Memory Reactivation: An Exploratory Study

Abstract

Tinnitus is the phantom perception of sound which can severely impact quality of life, possibly resulting in sleep disturbances. As there is currently no cure for tinnitus, attention has focused on novel treatments. Targeted Memory Reactivation (TMR) strengthens newly learned memories by re-presenting a stimulus present at learning during subsequent sleep. Stimulus-cued memories are typically recalled better than non-cued memories, highlighting the therapeutic potential of TMR. The current study explores the use of visualisation therapy (visualisation) and visualisation therapy paired with self-selected nature sounds (visualisation with sound) for reducing tinnitus perception and sleep disturbances. Nature sounds were continuously re-presented during subsequent sleep to strengthen tinnitus therapy memories. Twelve subjects with bothersome tinnitus and sleep disturbances participated in the randomised crossover study. Baseline measurements of tinnitus perception and sleep quality were taken and repeated following visualisation and visualisation with sound (one week each). Both treatments were thirty minutes in duration and performed every night before sleep. Tinnitus perception was measured by the Tinnitus Severity Numeric Scale and Sleep and Tinnitus Numeric Scale. Sleep quality was measured by actigraphy estimates of total sleep time, sleep onset latency, sleep fragmentation, and wake after sleep onset. Repeated measures of attention and emotion, via the Attention and Performance Self-Assessment and Hospital Anxiety and Depression Scale, were obtained to help explain any observed effects. Neither treatment condition elicited statistically significant reductions in ratings of tinnitus perception. Sleep onset latency significantly improved following both treatment conditions. None of the other sleep quality markers demonstrated significant change. Visualisation significantly reduced anxiety and improved attention. Visualisation with sound also elicited a significant reduction in anxiety. Overall, the TMR condition did not yield better outcomes than visualisation alone in measures of tinnitus perception and sleep quality. While both treatments positively impacted anxiety and sleep onset latency, the effect was most attributable to visualisation alone. The ineffectiveness of visualisation therapy on tinnitus perception and methodological limitations underpin these results. Future research describing the optimal parameters needed for the treatment type, conditioning stimulus, and desired outcome are required in order to fully realise the clinical potential of TMR.